Intrathecal Port (Spinal Port)

What is it?

An intrathecal port is a system that delivers pain medicine into the cerebrospinal fluid around the spinal cord, known as the intrathecal space. It has two parts: a thin catheter placed in the spinal canal, and a small reservoir (port) under the skin to which the catheter is connected. Medicine is given through a special needle inserted into the port through the skin, which is attached to a portable pump.

Medicine delivered into the cerebrospinal fluid reaches the structures that carry pain signals directly, so a very small fraction of the oral dose may be enough. The treatment is considered for selected people whose cancer pain cannot be controlled with medicines.

When is it considered?

Most cancer pain can be controlled with medicines. An intrathecal port may be considered when pain continues despite increasing doses of strong painkillers, or when side effects such as marked drowsiness, confusion or nausea make it impossible to continue treatment. It is used especially for pain below the diaphragm (the muscle that separates the chest from the abdomen), that is, in the abdomen, pelvis, lower back and legs.

How long treatment is likely to be needed also shapes the choice. For shorter-term needs, an epidural catheter may be enough. When treatment is expected to last weeks or months, the intrathecal route usually has advantages: lower doses, fewer catheter problems and fewer side effects. For longer-term use, fully implanted programmable drug pumps are also an option.

The decision is made jointly by the pain, oncology and palliative care teams. International recommendations stress that this treatment should be delivered and regularly monitored by an experienced team.

How does it work?

Opioids (morphine-type painkillers) given into the intrathecal space bind directly to receptors involved in pain transmission in the spinal cord. Other medicines, such as a local anaesthetic, can be added to the mixture if needed. Because the dose is very low, less medicine reaches the rest of the body, and side effects such as drowsiness and constipation are expected to lessen.

The pump delivers a continuous dose and often lets you take extra doses within set limits when pain increases. This also helps control sudden flare-ups of pain during the day.

Before the procedure

A trial is carried out before the port is implanted. This may involve a single dose of medicine given through the lower back, or medicine given for a few days through a temporary catheter. During the trial, changes in pain, daily function and side effects are monitored closely.

Your scans are reviewed, and clotting tests and a blood count are checked. Blood thinners are planned with the team. Who will look after the port, change the needle and refill the medicine, and where this will happen, are agreed in advance. You and your family will be told how the system works, the possible risks and the alternatives before you give consent.

What happens during the procedure?

The procedure is carried out in an operating theatre under sterile conditions. Local anaesthesia with sedation is usually used, although general anaesthesia may be preferred for some people. A needle is inserted into the intrathecal space through the lower back, and the thin catheter is advanced to the planned level under fluoroscopy (live X-ray).

The catheter is then tunnelled under the skin to the lower chest wall or the abdomen, where it is connected to a port placed under the skin through a small incision, and the incisions are stitched. At the end of the procedure, a special needle is inserted into the port and connected to the pump, and the medicine is started.

After the procedure

In the first days, breathing, drowsiness, blood pressure and pain levels are monitored closely, and the dose is adjusted accordingly. Opioids taken by mouth are not stopped abruptly but reduced gradually to avoid withdrawal symptoms. The incision sites may be tender for a few days.

Before you go home, your family and the home care team are shown how to use the pump, care for the dressing and recognise warning signs. The needle in the port and the dressing are changed at set intervals under sterile conditions by trained healthcare staff.

When might you notice results?

The effect begins soon after the medicine reaches the cerebrospinal fluid, and changes in pain are often noticed in the first days. Finding the right dose and combination of medicines may take a few days, and the dose may be adjusted as the illness progresses.

Results vary from person to person. An intrathecal port does not always remove pain completely; the aim is to bring pain down to a manageable level with acceptable side effects and to improve quality of life. To discuss the right option for you, you can request a consultation.